Application of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIANG Heng ¹ ,  JIANG Xin ² , PENG Mingxing ² , LIU Lijun ²

1. Department of Orthopedics, Mianzhu People’s Hospital, Mianzhu Sichuan, 618200, P.R.China;
2. Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

JIANG Xin, Email: jiangxin1975@126.com

Keywords：

Knee flexion contracture; child; knee lysis; arthroscope; Ilizarov external fixation technology

DOI：

10.7507/1002-1892.201906007

Video：

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Objective To investigate the effectiveness of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children.Methods A retrospective analysis was made on 12 children (12 knees) with severe knee pathological flexion contracture deformity who were treated with internal and external lysis and Ilizarov external fixation between August 2012 and January 2017. There were 9 boys and 3 girls with an age of 3-12 years (mean, 8.4 years). There were 8 cases of tuberculosis, 3 cases of haemophilia A, and 1 case of residual deformity after extensive hemangioma drug injection. The disease duration ranged from 5 months to 4 years, with an average of 20.3 months. The degree of knee contracture was (67.42±23.30)°, and the range of motion of knee was (38.33±14.98)°. The preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score was 78.42±15.57. The complication was observed after operation, and the degree of knee contracture, range of motion, and WOMAC score at 3 months and 1 year after operation were recorded and compared with those before operation.Results The operations completed successfully in all children. All the 12 cases were followed up 9-24 months (mean, 14.5 months). All incisions healed by first intention after operation. The knee function of all children improved significantly and the weight-bearing walking function of the lower limbs restored. The degree of knee contracture, range of motion, and WOMAC score were significantly improved at 3 months and 1 year after operation (P<0.05), but there was no significant difference between 3 months and 1 year after operation (P>0.05).Conclusion For severe knee pathological flexion contracture deformity in children, application of internal and external lysis combined with Ilizarov external fixation has advantages, such as small trauma, rapid recovery, and early postoperative knee function training, and good effectiveness.

Citation： XIANG Heng, JIANG Xin, PENG Mingxing, LIU Lijun. Application of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1521-1526. doi: 10.7507/1002-1892.201906007 Copy

1.	Herzenberg JE, Davis JR, Paley D, et al. Mechanical distraction for treatment of severe knee flexion contractures. Clin Orthop Relat Res, 1994, (301): 80-88.
2.	陳建文, 秦泗河. 膝關節屈曲攣縮外科治療進展. 中國矯形外科雜志, 2004, 12(17): 1339-1341.
3.	秦泗河, 陳建文, 夏和桃, 等. Ilizarov 技術矯治重度膝關節屈曲攣縮畸形的臨床研究. 中國矯形外科雜志, 2007, 15(8): 583-586.
4.	van Bosse HJP, Pontén E, Wada A, et al. Treatment of the lower extremity contracture/deformities. J Pediatr Orthop, 2017, 37(Suppl 1): S16-S23.
5.	Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988, 15(12): 1833-1840.
6.	Balci HI, Kocaoglu M, Eralp L, et al. Knee flexion contracture in haemophilia: treatment with circular external fixator. Haemophilia, 2014, 20(6): 879-883.
7.	Yoon KH, Bae DK, Kim HS, et al. Arthroscopic synovectomy in haemophilic arthropathy of the knee. Int Orthop, 2005, 29(5): 296-300.
8.	Kiely PD, McMahon C, Smith OP, et al. The treatment of flexion contracture of the knee using the Ilizarov technique in a child with haemophilia B. Haemophilia, 2003, 9(3): 336-339.
9.	Zhai J, Weng X, Zhang B, et al. Management of knee flexion contracture in haemophilia with the Ilizarov technique. Knee, 2019, 26(1): 201-206.
10.	Bousbaa H, Amhajji L. Hemangioma of the knee. Pan Afr Med J, 2017, 27: 225.
11.	Ramseier LE, Exner GU. Arthropathy of the knee joint caused by synovial hemangioma. J Pediatr Orthop, 2004, 24(1): 83-86.
12.	郭保逢, 秦泗河, 任龍喜, 等. Ilizarov 技術治療下肢血管瘤致屈膝畸形. 中國矯形外科雜志, 2016, 24(17): 1570-1574.
13.	Shen HL, Xia Y, Li P, et al. Arthroscopic operations in knee joint with early-stage tuberculosis. Arch Orthop Trauma Surg, 2010, 130(3): 357-361.
14.	Carender CN, Akoh CC, Kowalski HR. Mycobacterium tuberculosis monoarthritis of the knee in children: A case report. Iowa Orthop J, 2018, 38: 17-23.
15.	Taylor D, Connor J, Church C, et al. The effectiveness of posterior knee capsulotomies and knee extension osteotomies in crouched gait in children with cerebral palsy. J Pediatr Orthop B, 2016, 25(6): 543-550.
16.	Damsin JP, Ghanem I. Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique. J Bone Joint Surg (Br), 1996, 78(1): 140-144.
17.	張子陽, 竇雪嬌, 魏在榮. 應用 Ilizarov 技術治療燒傷后膝關節屈曲攣縮畸形. 中國修復重建外科雜志, 2018, 32(10): 1271-1274.
18.	秦泗河, 夏和桃. 改良 Ilizarov 技術矯治兒童膝關節重度屈曲畸形. 中華骨科雜志, 2002, 22(2): 125-126.
19.	董佩龍, 唐曉波, 王健, 等. 關節鏡下清理術聯合 Ilizarov 牽伸術治療膝關節骨關節炎的近期療效觀察. 中國修復重建外科雜志, 2017, 31(7): 794-798.
20.	王振軍, 秦泗河, 焦紹鋒, 等. Ilizarov 技術結合矯形支具治療復雜膝關節畸形的臨床研究. 中國矯形外科雜志, 2013, 21(17): 1775-1777, 1798.

1. Herzenberg JE, Davis JR, Paley D, et al. Mechanical distraction for treatment of severe knee flexion contractures. Clin Orthop Relat Res, 1994, (301): 80-88.
2. 陳建文, 秦泗河. 膝關節屈曲攣縮外科治療進展. 中國矯形外科雜志, 2004, 12(17): 1339-1341.
3. 秦泗河, 陳建文, 夏和桃, 等. Ilizarov 技術矯治重度膝關節屈曲攣縮畸形的臨床研究. 中國矯形外科雜志, 2007, 15(8): 583-586.
4. van Bosse HJP, Pontén E, Wada A, et al. Treatment of the lower extremity contracture/deformities. J Pediatr Orthop, 2017, 37(Suppl 1): S16-S23.
5. Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol, 1988, 15(12): 1833-1840.
6. Balci HI, Kocaoglu M, Eralp L, et al. Knee flexion contracture in haemophilia: treatment with circular external fixator. Haemophilia, 2014, 20(6): 879-883.
7. Yoon KH, Bae DK, Kim HS, et al. Arthroscopic synovectomy in haemophilic arthropathy of the knee. Int Orthop, 2005, 29(5): 296-300.
8. Kiely PD, McMahon C, Smith OP, et al. The treatment of flexion contracture of the knee using the Ilizarov technique in a child with haemophilia B. Haemophilia, 2003, 9(3): 336-339.
9. Zhai J, Weng X, Zhang B, et al. Management of knee flexion contracture in haemophilia with the Ilizarov technique. Knee, 2019, 26(1): 201-206.
10. Bousbaa H, Amhajji L. Hemangioma of the knee. Pan Afr Med J, 2017, 27: 225.
11. Ramseier LE, Exner GU. Arthropathy of the knee joint caused by synovial hemangioma. J Pediatr Orthop, 2004, 24(1): 83-86.
12. 郭保逢, 秦泗河, 任龍喜, 等. Ilizarov 技術治療下肢血管瘤致屈膝畸形. 中國矯形外科雜志, 2016, 24(17): 1570-1574.
13. Shen HL, Xia Y, Li P, et al. Arthroscopic operations in knee joint with early-stage tuberculosis. Arch Orthop Trauma Surg, 2010, 130(3): 357-361.
14. Carender CN, Akoh CC, Kowalski HR. Mycobacterium tuberculosis monoarthritis of the knee in children: A case report. Iowa Orthop J, 2018, 38: 17-23.
15. Taylor D, Connor J, Church C, et al. The effectiveness of posterior knee capsulotomies and knee extension osteotomies in crouched gait in children with cerebral palsy. J Pediatr Orthop B, 2016, 25(6): 543-550.
16. Damsin JP, Ghanem I. Treatment of severe flexion deformity of the knee in children and adolescents using the Ilizarov technique. J Bone Joint Surg (Br), 1996, 78(1): 140-144.
17. 張子陽, 竇雪嬌, 魏在榮. 應用 Ilizarov 技術治療燒傷后膝關節屈曲攣縮畸形. 中國修復重建外科雜志, 2018, 32(10): 1271-1274.
18. 秦泗河, 夏和桃. 改良 Ilizarov 技術矯治兒童膝關節重度屈曲畸形. 中華骨科雜志, 2002, 22(2): 125-126.
19. 董佩龍, 唐曉波, 王健, 等. 關節鏡下清理術聯合 Ilizarov 牽伸術治療膝關節骨關節炎的近期療效觀察. 中國修復重建外科雜志, 2017, 31(7): 794-798.
20. 王振軍, 秦泗河, 焦紹鋒, 等. Ilizarov 技術結合矯形支具治療復雜膝關節畸形的臨床研究. 中國矯形外科雜志, 2013, 21(17): 1775-1777, 1798.

Chinese Journal of Reparative and Reconstructive Surgery

Application of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children

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